Clinical Documentation and Informatics Coordinator

2 weeks ago

Welland, Canada Niagara Health System Full time

Reporting to the Administrator, the Clinical Documentation & Informatics Lead is responsible for maintaining the home's clinical documentation system, and electronic Resident Assessment Instrument (RAI) system, ensuring that the systems are managed in a manner that is compliant with Provincial and Regional Standards, related legislation and polices.

**RESPONSIBILITIES**:
Maintains the home's clinical documentation system, and electronic Resident Assessment Instrument (RAI) system.
Acts as systems administrator in the home for clinical documentation systems, maintaining and evaluating in-home systems, assigning and altering user rights, and ensuring system upgrades.
- Assesses issues with systems or processes and collaboratively develops solutions.
- Ensures compliance with RAI and clinical documentation processes in relation to home policies, MOHLTC regulations, College Standards and inter-RAI requirements.
- Liaises with vendors to support clinical documentation systems.
- Ensures the timely completion of MDS assessments, resident assessment protocols, and care plans.
- Ensures that the resident assessment schedule is developed, completed and accessible to staff.
- Audits RAI and clinical documentation records for accuracy and data integrity.
- Leads RAI and clinical documentation process developments and improvements in the home, to ensure data accuracy, efficient data collection, assessment completion, and data utilization.
Provides one-on-one support for staff struggling to document resident status and care activities.
- Analyzes management information and generates regular reports from the MDS-RAI, and other relevant systems, to be used in clinical and management decision-making.
- Ensures that data submission requirements and processes are in place and operating effectively.
- Ensures that monthly electronic submissions are accurate, and properly sent through to the MOHLTC.
- Provides input on staff performance to accountable managers for staff appraisal purposes, participating in transfer, promotion, demotion and discipline decisions.

**QUALIFICATIONS**:

- At least 3 years of clinical experience within a Long-Term Care Home environment.
- Recognized RAI credentials or equivalent.
- At least 1 year of project lead experience.
- Current regulated or licensed health care practitioner (e.g. RPN, RN, BSW, MSW, Dietitian).
- Excellent knowledge and experience with adult education strategies/facilitation.
- Excellent knowledge and experience with computerized clinical documentation systems and RAI is required.
- Certificate in Adult Education or Training is preferred.
- Knowledge of interdisciplinary team members, Ministry documentation standards and home policies on assessment and care planning is preferred.
- Flexible, self-directed and able to work effectively with mínimal supervision
- Consistent and regular attendance required
- Vaccines (COVID-19 and others) are a new hire requirement of the job unless you have an exemption based on medical or on a ground pursuant to the Ontario Human Rights Code
Recruitment Specialist: Emily Fabiano
- We are especially interested in connecting if you..._
- Value diversity, equity and inclusion;_
- Are excited about being part of a respectful and hard-working team in the beautiful Region of Niagara;_
- Identify as a member of one or more of the following equity-deserving groups: Indigenous persons, racialized, persons with disabilities, persons of diverse sexual orientations and gender identities and all others who may contribute to the further diversification of ideas._
- Have background or expertise in the healthcare environment, supporting patient care and providing extraordinary customer-service_
- In accordance with the Accessibility for Ontarians with Disabilities Act, 2005 and the Ontario Human Rights Code, Niagara Health will provide accommodations through the recruitment process to applicants with disabilities. If selected to participate in the recruitment and selection process, please inform Human Resources of the nature of any accommodation(s) that you may require in respect of any materials or processes used to ensure your equal participation._

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